Post-test Psychiatric Nursing

Question 1

Repeated occurrence of stress, impulse, depression will change the sensitivity of the brain or the threshold

Answer 1

Kindling

Question 2

Major neurotransmitters and their function

Answer 2

Excitatory
1. Dopamine (cognition and emotion)
2. Norepinephrine and epinephrine
3. Acetylcholine (sleep and muscle)
4. Glutamate (neurotoxic if high)

Inhibatory
1. Serotonin (almost everything)
2. Acetylcholine

Neuromodulators
1. Histamine
2. Neuropeptides

Question 3

The client promises not to attempt suicide within 24 hours; not legally-bounded but a written promise

The patient should inform when tendencies rise.

Answer 3

No-suicide contract

Question 4

Side effects of psychotropic drugs when blocking histamine

Answer 4

1. Weight gain
2. Sedation
3. Hypotension

Question 5

No suicide contract implies this if the client shares the tendency to commit

Answer 5

Constant 24-hour, one-on-one observation at arm’s length

Question 6

Problems with glutamate leads to these conditions

Answer 6

1. Alzheimer’s disease
2. Huntington

*Glutamate is neurotoxic and evident in stroke and hypoglycemia.

Question 7

Problems with acetylcholine is evident in patients with or leads to:

Answer 7

1. Alzheimer’s disease
2. Myasthenia gravis

Question 8

Problems of dopamine lead to what disease

Answer 8

1. Increase leads to schizophrenia
2. Parkinson’s disease

*Dopamine 1 is for the heart; dopamine 2 is for the brain

DOC: Levodopa

Question 9

Problems with norepinephrine and epinephrine leads to:

Answer 9

Norepinephrine: anxiety disorders and depression

Question 10

Brain imaging technology, results, and duration

Answer 10

Structural Image
1. CT Scan 20-40 mins
2. MRI Scan 45 mins

Functional
1. PET Scan (with radioactive tracer) 2-3 hrs

Question 11

The importance of tapering psychotropic medication

Answer 11

1. This avoids rebound withdrawal (temporary return of symptoms)
2. Withdrawal (new symptoms related to the discontinuation of the drug)

Question 12

Antipsychotics are prescribed for patients with:

Answer 12

1. Psychosis
2. Schizophrenia
3. Schizoaffective disorder
4. Manic phase of bipolar disorder
5. Transient psychotic attack in borderline personality

Off-label use
1. Anxiety and insomnia

Question 13

The difference between the three generations of antipsychotics based on the dopamine levels

Answer 13

• First generation mainly antagonizes D2 receptors leading to higher risk for EPS
• Second generation weakly blocks D2 which leads to lesser EPS
• Second generation also inhibits re-uptake of serotonin, addressing the negative symptoms
• Third generation stabilize dopamine output; without EPS
• Common S/E for 3rd generation: sedation, weight gain, akathisia, headache, anxiety, and nausea

Question 14

The four side effects of extrapyramidal side effects (EPS)

Answer 14

1. Acute dystonia
2. Pseudoparkinsonism
3. Akathisia
4. Tardive dyskinesia (irreversible)

Question 15

The cause of the development of EPS

Answer 15

1. Blockage of D2 receptors in the midbrain region of the brain stem

Question 16

The symptoms manifested with the drug of choice for Acute Dystonia (1st stage of EPS)

Answer 16

This is mainly rigidity:
1. Torticollis/wry neck or stiff neck
2. Oculogyric crisis
3. Opisthotonos

DOC: dipenhydramine (Bendaryl) & benztropine (Cogentin)
*May be given IM for rapid relief
*May be given the anticholinergic and benzodiazepine

Question 17

The manifestation and DOC for akathisia (2nd of EPS):

Answer 17

This mainly leads to restlessness and pacing:
1. Rocking motion

DOC: propranolol (blocks norepinephrine)
*Treated with changing of antipsychotic medication; use of beta-blocker, anticholinergic, and benzodiazpeine

Question 18

The manifestation and DOC for pseuoparkinsonism:

Answer 18

1. Bradykinesia (slow movement)
2. Shuffling gait
3. Cog wheel movement (robot movement)
4. Coarse pill-rolling movement

DOC: amantadine (anticholinergic agent/dopamine-agonist)

Question 19

The manifestation and DOC of tardive dyskinesia:

Answer 19

This is related to involuntary facial movements; irreversible.
1. Lip smacking
2. Facial grimacing
3. Tongue protrusion
3. Choreiform movement of the limbs

DOC: clozapine (Clozaril)

DOC for EPS in general: Benztropine, Diphenhydramine, Biperiden (Akineton), Amantadine (Symmetrel)

Question 20

The effects of the following drugs to the eyes:

Answer 20

1. Constriction: opioid
2. Red eyes: marijuana, cocaine, and benzodiazepine
3. Dilation: cocaine, LSD, and methamphetamine

Question 21

A potentially fatal idiosyncratic reaction to an antipsychotic drug leading to S/Sx of (1) muscle rigidity, high fever of unknown origin, and dysautonomia—with elevated enzymes of creatine phosphokinase

Onset: 24-72 hours
Common in FGA

Risk factors: dehydration and poor nutrition

Answer 21

Neuroleptic Malignant Syndrome (NMS)

Question 22

The most common cause of death with neuroleptic malignant syndrome (NMS)

Answer 22

Respiratory and cardiac arrest

Question 23

The priority action and the two drug of choice for Neuroleptic Malignant Syndrome (NMS)

Answer 23

Priority: stop the medication and vital signs taking

DOC:
1. Valium (to decrease rigidity)
2. Dantrolene Sodium (muscle relaxant)

Question 24

The most common antipsychotic to cause agranulocytosis:

Answer 24

Clozapine (2nd generation antipsychotic)

Question 25

This refers to the failure of the bone marrow to produce adequate white blood cells or the proliferation of immature WBCs resulting to decreased mature WBCs—termed as “crowd out phenomenon” Onset: 18-36 weeks Common s/sx: ulcerative sore throat/dry throat/tonsilitis

Answer 25

Agranulocytosis

Question 26

The cause of death of agranulocytosis:

Answer 26

Septic shock

Question 27

The management of agranulocytosis

Answer 27

1. Stop the medication 2. Anticipate order for CBC, to specifically check the neutrophils d/t agranulocytosis > neutropenia 3. Administer macrolide (wide-spectrum antibiotics)

Question 28

How frequent should patients with antipsychotics monitor WBC count?

Answer 28

1. Weekly for the first six months 2. Fortnight >6 months *>3.5 WBC is required before dispensing clozapine

Question 29

The best organ to check for jaundice

Answer 29

Jaundice at the hard palate

Question 30

The first drug used to treat tardive dyskinesia:

Answer 30

Valbenazine (-benazine)

Question 31

Anticholinergic S/E

Answer 31

B - lurred vision U - rinary retention C - onstipation O - rthostatic hypotension P - hotosensitivity A - mnesia N - ight disturbances D - ry mouth A - taxia N - ausea

Question 32

Other side effects when taking antipsychotic drugs

Answer 32

1. Elevate prolactin levels 2. Diminished libido 3. Weight gain especially 2nd generation 4. Sedation 5. Sexual dysfunction: ED, vaginismus, dyspareunia 6. Menstrual irregularities *Atypical have increased risk for hyperglycemia and diabetes d/t increased appetite

Question 33

The only 2nd generation antipsychotic that does not cause anticholinergic side effect

Answer 33

Resperidone

Question 34

Protocol if missed dose of antipsychotics

Answer 34

1. If 3-4 hours after, take the medication. 2. >4 hours, skipped the medication

Question 35

Aside from treating depression, these are off-label use of antidepressant drugs

Answer 35

1. Chronic pain 2. Migraine headaches 3. Panic disorder 4. Sleep apnea 5. Eating disorders

Question 36

The side effects of MAOI

Answer 36

1. Weight gain 2. Orthostatic hypotension 3. WOF: Hypertensive crisis (avoid tyramine); do not combine with other MAOIs, TCAs, opioids, and antihypertensives Pros: 1. Low incidence of sedation 2. Low incidence of anticholinergic effects